Understanding hepatic encephalopathy

Von Willebrand factor indicates bacterial translocation, inflammation, and procoagulant imbalance and predicts complications independently of portal hypertension severity

“…In contrast, although vWF levels were linked to the development of grade 3/4 HE in univariate analysis, they were not independently predictive in multivariate analysis. This might be explained by the complex pathogenesis of HE, with bacterial translocation‐induced inflammation being only a small part of the puzzle …”

Neurological Complications Occurring After Liver Transplantation: Role of Risk Factors, Hepatic Encephalopathy, and Acute (on Chronic) Brain Injury

“…Most patients display neurological symptoms before LT due to HE. HE is a classical complication of acute or chronic liver disease and/or portosystemic shunt . Type A HE corresponds to ALF, and type C HE is associated with cirrhosis.…”

“…As a result, MHE can only be detected with neuropsychological testing, is much more difficult to diagnose, and can easily be missed before LT. Even if HE symptoms mostly disappear after LT, the existence of HE sequelae is still debated . Several data suggest that the metabolic component of HE almost reverses after LT, whereas the structural component may persist .…”

Altered distal‐proximal temperature gradient as a possible explanation for sleep‐wake disturbances in cirrhotic patients

“…Interestingly, the hypothalamus does not have any blood‐CNS barrier, and it constitutes a privileged site for cross‐talk between the brain and periphery . In cirrhotic patients, the different substances present in the blood because of altered hepatic functions and porto‐systemic shunts, ammonia, bile acids, cytokines, could directly influence hypothalamic physiology . The correlation that the authors found between minimal proximal temperature and inflammatory markers, IL‐6 and CRP, do not enable answering this question as systemic inflammation can modulate both vasodilatation and hypothalamic functioning.…”

“…17 In cirrhotic patients, the different substances present in the blood because of altered hepatic functions and porto-systemic shunts, ammonia, bile acids, cytokines, could directly influence hypothalamic physiology. 18 The correlation that the authors found between minimal proximal temperature and inflammatory markers, IL-6 and CRP, do not enable answering this question as systemic inflammation can modulate both vasodilatation and hypothalamic functioning. This correlation with inflammatory markers should be further explored in future studies, and the question whether these findings are specific for the cirrhosis state or related to an inflammatory state should be answered.…”